CPT code 92371 is used for billing the repair and adjustment of spectacles.
CPT code 92371 is used to denote a medical service specifically for the repair and adjustment of spectacles. This code is utilized by healthcare providers when submitting claims for reimbursement for services related to fixing or modifying a patient's glasses to ensure proper fit and function.
For the CPT code 92371, which pertains to the repair and adjustment of spectacles, several modifiers may be applicable depending on the specific circumstances of the service provided. Here is an ordered list of potential modifiers and the reasons for their use:
1. -25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service: This modifier is used if the provider performs a significant, separate evaluation and management service on the same day as the repair.
2. -52 - Reduced Services: This modifier could be used if the service provided was reduced in comparison to the usual service described by the CPT code, such as a minor adjustment that did not require extensive work.
3. -58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: If the spectacle repair is part of a planned sequence of treatments following an initial service, this modifier would be appropriate.
4. -59 - Distinct Procedural Service: This modifier is used to indicate that the service is distinct from other services performed on the same day, which might include separate instances of repairs on different spectacles.
5. -76 - Repeat Procedure by Same Physician: Use this modifier if the same provider had to repeat the spectacle repair during the same session due to incomplete or insufficient repair initially.
6. -79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: If the repair is performed during the postoperative period of another unrelated procedure and is not considered a complication or related service, this modifier would be applicable.
7. -RT and -LT - Right Side and Left Side: These modifiers are used to specify which spectacle (right or left) was repaired if only one needed adjustment.
Each of these modifiers serves to provide additional information that can affect billing and reimbursement processes, ensuring that the services rendered are accurately documented and charged.
CPT code 92371, which pertains to the repair and adjustment of spectacles, is generally not reimbursed by Medicare. Medicare typically does not cover services related to eyeglasses or contact lenses except in specific circumstances, such as post-cataract surgery with intraocular lens placement. For routine eyeglass or contact lens services, including repairs and adjustments like those described by CPT code 92371, patients are usually responsible for the costs.
However, it's important for healthcare providers to verify coverage specifics directly with Medicare or through the patient's Medicare Advantage Plan, as there can be variations in coverage based on individual policy details. If a provider finds that a service related to this code is covered under exceptional circumstances, the reimbursement amount would be determined based on the Medicare Physician Fee Schedule applicable to the geographic location where the service is provided.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and identifying underpayments with precision down to the CPT code level, including specific codes like 92371 for repair and adjustment of spectacles. Schedule a demo today to see how RevFind can help you secure correct payments from each individual payer, ensuring your healthcare practice is fully compensated for the services provided.
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